title: Unaltered oncological outcomes of radical cystectomy with extended lymphadenectomy over three decades.
abstract: OBJECTIVE
  To evaluate oncological outcome trends over the last three decades in patients after radical cystectomy (RC) and extended pelvic lymph node (LN) dissection.
  
  
  METHODS
  Retrospective analysis of the University of Southern California (USC) RC cohort of patients (1488 patients) operated with intent to cure from 1980 to 2005 for biopsy confirmed muscle-invasive urothelial bladder cancer. To focus on outcomes of unexpected (cN0M0) LN-positive patients, the USC subset was extended with unexpected LN-positive patients from the University of Berne (UB) (combined subgroup 521 patients). Patients were grouped and compared according to decade of surgery (1980-1989/1990-1999/≥2000). Survival probabilities were calculated with Kaplan-Meier plots, log-rank tests compared outcomes according to decade of surgery, followed by multivariable verification.
  
  
  RESULTS
  The 10-year recurrence-free survival was 78-80% in patients with organ-confined, LN-negative disease, 53-60% in patients with extravesical, yet LN-negative disease and ≈30% in LN-positive patients. Although the number of patients receiving systemic chemotherapy increased, no survival improvement was noted in either the entire USC cohort, or in the combined LN-positive USC-UB cohort. In contrast, patient age at surgery increased progressively, suggesting a relative survival benefit.
  
  
  CONCLUSIONS
  Radical surgery remains the mainstay of therapy for muscle-invasive bladder cancer. Yet, our study reveals predictable outcomes but no survival improvement in patients undergoing RC over the last three decades. Any future survival improvements are likely to result from more effective systemic treatments and/or earlier detection of the disease.
authors.affiliation: University of Southern California (USC) Institute of Urology, Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, USC, Los Angeles, CA, USA; Department of Urology, University of Bern (UB), Bern, Switzerland.
authors.forename: Pascal
authors.initials: P
authors.lastname: Zehnder
authors.forename: Urs E
authors.initials: UE
authors.lastname: Studer
authors.forename: Eila C
authors.initials: EC
authors.lastname: Skinner
authors.forename: George N
authors.initials: GN
authors.lastname: Thalmann
authors.forename: Gus
authors.initials: G
authors.lastname: Miranda
authors.forename: Beat
authors.initials: B
authors.lastname: Roth
authors.forename: Jie
authors.initials: J
authors.lastname: Cai
authors.forename: Frédéric D
authors.initials: FD
authors.lastname: Birkhäuser
authors.forename: Anirban P
authors.initials: AP
authors.lastname: Mitra
authors.forename: Fiona C
authors.initials: FC
authors.lastname: Burkhard
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Dorin
authors.forename: Siamak
authors.initials: S
authors.lastname: Daneshmand
authors.forename: Donald G
authors.initials: DG
authors.lastname: Skinner
authors.forename: Inderbir S
authors.initials: IS
authors.lastname: Gill
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D055815:Young Adult